title: Comparison of a low-pressure and a high-pressure pulsatile lavage during débridement for orthopaedic implant infection.
abstract: BACKGROUND
  The aim of our study was to compare the effectiveness of high-pressure pulsatile lavage and low-pressure lavage in patients with an orthopaedic implant infection treated with open débridement followed by antibiotic treatment.
  
  
  METHODS
  Patients with an orthopaedic implant infection requiring open débridement from January 2008 to August 2009 were randomized prospectively to a low-pressure or a high-pressure pulsatile lavage arm. Relevant information about demographics, co-morbidity, type of implant, microbiology data, surgical treatment, and outcome were recorded. Comparison of proportions was made using χ(2) test or Fisher exact test when necessary. The Kaplan-Meier survival method was used to estimate the cumulative probability of treatment failure from open débridement to the last visit.
  
  
  RESULTS
  Seventy-nine patients were included. There were no differences between the main characteristics between both groups (p > 0.05). Mean (SD) age of the whole cohort was 70.2 (11.9) years. There were 46 infections on knee prosthesis, 17 on hip prosthesis, 7 on hip hemiarthroplasties and 9 on osteosynthesis devices. There were 69 acute post-surgical infections, 8 acute haematogenous infections and 2 chronic infections. The most common microorganisms isolated were coagulase-negative Staphylococci in 34 cases, Staphylococcus aureus in 26 and Escherichia coli in 19 cases. There were 30 polymicrobial infections. A total of 42 and 37 patients were randomized to a high-pressure pulsatile or a low-pressure lavage, respectively. There was no difference in the success rate between both arms (80.9 vs. 86.5%, p = 0.56).
  
  
  CONCLUSIONS
  The use of a high-pressure pulsatile lavage during open débridement of implant infections had a similar success rate as a low-pressure lavage.
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Bone and Joint Infection Unit, Hospital Clínic of Barcelona, University of Barcelona, Spain. e.munoz.mahamud@gmail.com
authors.forename: E
authors.initials: E
authors.lastname: Muñoz-Mahamud
authors.forename: S
authors.initials: S
authors.lastname: García
authors.forename: G
authors.initials: G
authors.lastname: Bori
authors.forename: J C
authors.initials: JC
authors.lastname: Martínez-Pastor
authors.forename: J A
authors.initials: JA
authors.lastname: Zumbado
authors.forename: J
authors.initials: J
authors.lastname: Riba
authors.forename: J
authors.initials: J
authors.lastname: Mensa
authors.forename: A
authors.initials: A
authors.lastname: Soriano
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003646:Debridement / Q000379:methods*; D004927:Escherichia coli Infections / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011312:Pressure; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000188:drug therapy / Q000628:therapy*; D011673:Pulsatile Flow; D013203:Staphylococcal Infections / Q000628:therapy*; D007507:Therapeutic Irrigation / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents